Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study

Abstract

BackgroundOne-quarter of the world’s population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed.ObjectiveThe intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects.MethodsThe expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts.ResultsAll participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness.ConclusionsExpectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice.

An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial

“…Patients in our study did not make much use of the support offered. We do not know the real reasons for this, but the lack of initial face-to-face contact with the psychotherapist might have hampered the establishment of an adequate alliance—something that might merit interest for further studies [ 19 ].…”

“…Adults presenting with depressive symptoms in PC were randomized to receive either iTAU from their GP or an Internet-based intervention program (Smiling is Fun) for depression, in this case, either with psychotherapist support (LITG) or without it (CSG). The trial protocol of the study [ 16 ], the manual used to implement the program [ 17 ], and a study on expectations of depressed PC patients have already been published [ 18 , 19 ].…”

“…The Spanish version of BDI-II [ 19 ], as a continuous variable, was used as the primary outcome measure at time 1 (3 months after baseline). The BDI-II is one of the most widely used instruments to evaluate presence and severity of depressive symptoms.…”

e-CBT (myCompass), Antidepressant Medication, and Face-to-Face Psychological Treatment for Depression in Australia: A Cost-Effectiveness Comparison

“…Non-adherence to the myCompass program was an issue in the trial and hence the cost-effectiveness analysis. Although non-adherence may have implications for upscaling this intervention, qualitative evidence has shown that in many cases, patients withdraw for personal reasons such as improvement in symptoms (known as “e-attainers”) [ 59 , 60 ], not because of problems with the technology or the social environment [ 61 ]. Including programs such as myCompass as part of an integrated model allows clinicians to monitor interim outcomes and inform decisions on patient treatment pathways, in case some patients are negatively affected by the limitations in effectiveness of low-intensity treatments.…”

A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

“…Concerns about the clinical effectiveness of mental health services provided through internet-based interventions incited controversy among health care professionals worldwide (Montero-Marín et al, 2015;Du et al, 2013). The ambiguity regarding the effectiveness of iCBT programmes in treating depression and anxiety is apparent.…”